U.S. Aid Withdrawal for HIV ‘Devastating’

A mobile clinic supported by the President's Emergency Plan for AIDS Relief (PEPFAR) in South Africa. The U.S. announced it would cut off funding for HIV projects in the country. Credit: Instagram

BRATISLAVA, Jul 2 2026 (IPS) - A U.S. decision to cut off funding for HIV projects in South Africa has been condemned amid warnings it could be “catastrophic” for efforts to control the disease in the country.

At the start of last year, the White House had announced massive cuts to U.S. foreign aid, including to South Africa, significantly impacting some HIV projects in the country. Related IPS Articles South Africa: Activists Call for Greater Access to Newly-Launched HIV Prevention Drug XDR-TB Drug Trial Participants Continue to Celebrate its Success

But last month (June 2026), U.S. officials confirmed plans to begin a drawdown of what remaining financial support it was providing through the President’s Emergency Plan for AIDS Relief (PEPFAR), saying the money was no longer needed given South Africa’s wealth but also seemingly linking the move to the government’s failure to meet specific U.S. political demands.

HIV experts and activists have warned the abrupt ending to the funding – all financing is expected to end by early next year and funding for most projects is planned to be cut by the end of September this year, according to the U.S. State Department – could drive increased spread of the disease and many avoidable deaths in a country which already has the world’s highest HIV burden.

“The phased withdrawal of U.S. HIV funding from South Africa is likely to have significant implications for HIV prevention, treatment, and community health systems. The withdrawal of funding threatens a wide range of services, including community outreach programmes, HIV testing services, mobile clinics, data and monitoring systems, PrEP delivery, and targeted interventions for populations at highest risk of HIV acquisition,” Bruce Tushabe, an HIV activist and consultant with the South African Litigation Centre-SALC, told IPS.

For more than two decades, PEPFAR funding has been crucial to South Africa’s response to HIV and tuberculosis, providing around USD 8 billion since 2003 to civil society organisations, community health programmes, clinics, researchers, health worker salaries, and government institutions.

Data from PEPFAR itself shows that almost three quarters of people living with HIV in the country are on treatment with some form of support from the organisation.

PEPFAR’s funding is thought to have helped save millions of lives by strengthening and expanding access to prevention, treatment, care, and support services in South Africa.

While over the years HIV treatment has increasingly been covered by state funding – today the state procures 90% of Antiretrovirals (ARVs) using government funds, with the remaining 10% coming from the Global Fund to Fight AIDS, Tuberculosis and Malaria – PEPFAR money has remained essential for financing much prevention.

Activists say that the withdrawal of funding now, without a proper transition plan in place, could be devastating, especially given how hard prevention services have already been hit by the funding cuts announced in early 2025.

According to media reports in South Africa, thousands of jobs, including at frontline healthcare partners, have been lost because of those cuts.

Meanwhile, the Treatment Action Campaign (TAC), a South African HIV NGO, says community-led monitoring has shown that since the 2025 cuts, 82% of facility managers have reported staffing shortages, 15% of public healthcare users surveyed said waiting times were longer than usual, 30% of public healthcare users surveyed reported not being offered HIV testing when attending a health facility, and 28% of people said it took longer to collect ARVs.

“The withdrawal of this funding at this critical juncture, without an adequate transition plan, threatens to reverse hard-won gains in the fight against HIV and TB,” TAC said in a statement.

“These cuts are not abstract budget decisions. They have real consequences for people living with HIV, particularly adolescent girls and young women; sex workers; people who use drugs (PWUDs); transgender people; gay, bisexual and other men who have sex with men (GBMSM); migrants; and people living in poverty. Reduced access to testing, prevention, treatment adherence support, and community outreach will inevitably lead to increased HIV transmission, treatment interruptions, preventable illness, and avoidable deaths,” the group said.

Some studies have estimated a complete, unmanaged withdrawal of U.S. funding for HIV programmes could lead to as many as 296,000 additional HIV infections and up to 65,000 extra deaths by 2028.

Tushabe said there was particular concern over the impact of the funding withdrawal on key and vulnerable populations who often depend on community-led and network-based services that operate outside conventional healthcare facilities.

“Many of these services provide stigma-free, accessible, and trusted points of care that are not easily replaced within mainstream health systems,” he said.

The South African Department of Health has tried to play down the potential impact of the withdrawal of funding.

In a statement, it said that while the government had not officially been informed by the U.S. about the end of the funding, the move was not a surprise and  that the Health Ministry has been working on a “self-reliance plan” to minimise the impact of funding withdrawal since the cuts to U.S. foreign aid last year.